10110140CITY OF CUPERTINO BUILDING PERMIT /-- / /,e
BUILDING ADDRESS: 20400 STEVENS CREEK BOULEVARD BLVD, CONTRACTOR: NOVO CONSTRUCTION PERMIT NO: 10110140
4TI1 FLOOR
I OWNER'S NAME: CUPERTINO CITY CENTER BUILDINGS 14025 BOHANNON DR I DATE ISSUED: 12212010 I
OWNER'S PHONE: 6173749500 MENLO PARK, CA 94025 1PHONE NO: (650)701-1500
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL [I COMMERCIAL El
MINOR DEMO OF INTERIOR PARTITIONS BLDG 3.4TH
FLOOR
License Class Lic. q
Contractor
1 hereby affirm that l am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
1 hereby affirm under penalty of perjury one of the following two declarations:
t. 1 have and will maintain a certificate of consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
Z 1 have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
1 certify that I have read this application and slate that the above information is
correct. I agree to comply with all city and county ordinances and stale laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply with
all non -point source regulations per the Cupertino Municipal Code, Section 9.18.
Date
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
t. I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business & Professions Cade)
2. 1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code). pip
I hereby affirm under penalty of perjury one of the following three declarations:
1. 1 have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this peril is issued.
2. I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
3. 1 certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of Califomia. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I
must forthwith comply with such provisions or this permit shall be deemed
revoked. vo
APPLICANT CERTIFICATIQ
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Addition , thea cant understands and will comply with
all non -point source JgpAlatiopS)e ta upe ino Municipal Code, Section 9.18.
Datcf• i2 -Z J- Z6/,,v
Sq. F1 Floor Area:
Valuation: 54200
APN Number: 36901028.171.R4 I Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued byY�%��—r----Date:�Z��/ `t
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant: Dare:
ALL ROOF COVERINGSTO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Ilealth &
Safety Code, Section 25532(a) should 1 store or handle hazardous material.
Additionally, should 1 use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Ilealth & Safety Code, See1jaC
%35SP5, 25533, and 25534.
Owner(t e 1` (Q • Lr / . ?!a ,67
/ �� nary
CONSTRUCTION LENDING AGENCY
I hereby aDinn that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCIIITF.CT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
DEMOLITION
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
Ila'ADDRESS:
20400 stvnscrk blvd.
DATE: 11/19/2010
REVIEWED BY: bobs.
Meeh. Permit Flee:
APN: 3001 02-t
IBP#: 101101 L} -O
'VALUATION:
$4,200
*PERMIT TYPE: Demolition Permit
PIAN CIIECK TYPE:
PRIMARY Commercial Building
USE:
h"Ie'. /asp. V, r:
PENTAMATION 1COMMLDEM
PERMIT TYPE:
WORK
demo comm bldq offices ace
SCOPE
0.0
FEE ID FLR AREA
s.f.
IDEMOCOM 1,500
NOTE: These fees are based on the oreliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS tree Resohl[lon 09-051 Eff. 711/102
Bloch. /'/an Chock
Plumb. Plop Chock
Elec. flan Cherk
Meeh. Permit Flee:
I'lomh. Permit Fce:
Iilec. fermi! /,ed:
Odtnr Mech. Insp.
Other Plumb Insp.
Li 1y.
01he, Iilrr. Gra
,Meeh. My. Fee:
Ph pp It. ht..p. Fee,
h"Ie'. /asp. V, r:
NOTE: These fees are based on the oreliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS tree Resohl[lon 09-051 Eff. 711/102
FEE
QTY/FEE
MISC ITEMS
I'lun Check Fue:
Suppl. PC' Fee
Plnmh.A1,1e(:h.11ilec Plan Check:
Permit Fee:
$507.00
Suppl. Insp. Fee10 Reg. O OT
0.0
hrs
$0.00
Plumb.l:blech.Rilec Unit Fee:
Pltlnlh./,Fleclr:Iilec Permit Fee.
C rIn,PII'llfllan 7'0A'
.
lb.ousocal RL'1'Iew Fee.
tfnrk It'irhour PerntiO
Plalilling fees:
/ravel 00(4lill7enlllli0n Fee' S:
S1r011e M011011 Fee: IBSEISMICO
$0.88
Select an Administrative Item
Olde Slds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
1 $508.88
$0.00
TOTAL FEE:
$508.88
Revised: 11/08/2010
Sn'-.-
CIN OF
CUPERTINO
CITY OF CUPERTINO
DEMO
PERMIT APPLICATION FORM
011 C)lt-f
APN#� D /
Date: ( D
Building Address:
Fee Group
�0
Mailing Address (if different from building address):
Demo -Residential
Owner's Name:
Phone:
VL�
c /'7 - 37 LI — e7 .> -Do
Contra
Phone :CDS Lj-7(D. 15C) --S
ISFPOOL-DEM-
Fax: :1Q I 5C)
Contractor License #: —1 q
Cal Bldg Standards
Commission Fee
Cupertino Business License #: a
ALL PERMIT
TYPES
Contact:
�v
Phone:
Seismic Residential
Fax:
Residential ❑ Sq Footage Commercial V�b Sq Footage �.
Job Description: [Ll) 56 i )-L
vY pr �,71_r ',�7 C1L�
L
Valuation: vJ
Project Size: Express ❑ Standard Large ❑ Major ❑
Please complete relevant portions of the Green Building Checklist
& attach it to the application
or if applicable, include on the plan set & the sheet index.
Quantity
Fee ID
Fee Description
Fee Group
Permit Type
1DEMORES
Demo -Residential
B
ISFDWL-DEM
1DEMOPRES
Pool Demo Residential
B
ISFPOOL-DEM-
IBCBSC
Cal Bldg Standards
Commission Fee
B
ALL PERMIT
TYPES
1BSEISMICRE
Seismic Residential
B
Revised 01/07/09